What is Cystitis?

Cystitis is the medical term for a condition also known as ‘urinary tract infection’ (UTI) or simply bladder infection. Cystitis is a very common problem, especially among women: it is estimated that over half the women in Britain will suffer from it at some point in their lifetime [1].

Cystitis is one of the most common causes for attending medical consultations and its prevalence is thought to increase with age. An estimated 10-15% of women aged over 60 years have frequent bouts of cystitis [2]. Men and children can also be affected by cystitis but this is less common.

The main symptoms of cystitis are:

• Discomfort when urine is passed an a stinging/burning pain in the urethra (‘dysuria’)
• Frequency of urination and an urgent need to go, often only passing small amounts
• Urgency even when the bladder is empty
• Dark or cloudy urine, strong smelling urine

Other symptoms can include:

• Backache/pain over the bladder
• Fever or raised temperature, chills
• Blood in urine
• Fatigue
• Nausea
• Feeling unwell
• Moodiness
• Confusion (in old people)

These symptoms can present differently in individuals. A bout of cystitis often starts with a ‘shivery twinge’ just after passing urine. If not immediately taken care of, these symptoms may progress to a more intense burning pain.

We usually refer to a bacterial infection of the bladder when talking about cystitis.

Bacterial Cystitis

Cystitis is usually a bacterial infection of the bladder. Bacteria usually enter through the urethra (tube from the bladder to the outside) and ascend into the bladder where they adhere to the bladder wall.

The most common pathogens implicated in cystitis are E. Coli (Escherichia colior), Streptococcus faecalis, Enterobacteriaceae, Staphylococcus saprophyticus and Enterococcus. Other less common strains could include: Klebsiella, Proteus and Pseudomonas [2, 3].

All of these bacteria are commonly found in the gut microbiota (bacterial flora of the large intestine) and therefore are often present on the skin around the anus. It is believed that our own bacteria are usually the cause of cystitis.

In the bladder, these bacteria can secrete an enzyme called urease, which splits the urea (a waste material from protein metabolism) in urine, resulting in the production of ammonium salts. Ammonium salts are responsible for the burning sensation and the strong smell of urine. The bladder will increase frequency in order to flush the bacteria out. Moreover, bacteria weaken the protective lining of the bladder so that urine can cross over to the cells and capillaries that make up the bladder wall. This stimulates receptors that make you feel increased urgency to urinate. Over-stimulation also increases the sensation of frequency [4, 5].

It is believed that women suffer more often from cystitis because of the close vicinity of the urethra and anus and also the short length of the urethra compared to men.

Cystitis can be debilitating but is generally not considered to be dangerous. However, if left untreated bacteria may travel up the ureters into the kidneys, which may lead to infection and inflammation of the kidneys (pyelonephritis). This could potentially be dangerous and should always be treated. The presenting symptoms for kidney infection are usually [6]:

• Backache (middle back)
• Fevers
• Chills
• Diagnosis

How is cystitis diagnosed?

A specimen of mid-stream urine is usually taken into a sterile container and a first simple positive/negative test can be taken with appropriate test strips at home or at the GPs. If positive, the sample is sent to a lab to be cultured. The result will indicate what type of bacterium is present and how strong the infection is.

Common treatments for cystitis

• Preventative measures
• OTC remedies
• Antibiotics

Other types of cystitis [7]:

Radiation cystitis

Radiation therapy for cancer of the pelvic organs can potentially lead to injury of the bladder, which may result in symptoms such as pain and blood in the urine.

Immunotherapy cystitis

Immunotherapy given directly into the bladder (usually for cancer) may cause cystitis but drugs are usually given to avoid irritation.

Cystitis Glandularis/Cystitis Cystica

Chronic cystitis may result in the formation of blisters on the bladder lining. When these blisters are tiny, this condition is called cysitis cystica. In cystitis glandularis these blisters have a thicker lining and the bladder may take on the appearance of ‘cobblestones’.

Follicular Cystitis

In follicular cystitis there are formations of small nodules and follicles in the bladder. This is usually a chronic form of cystitis.

Eosinophilic Cystitis

Eosinophilic cystitis is characterized by a build-up of certain white blood cells called ‘eosinophils’ in the bladder. Symptoms may include chronic pain and frequency. This is a rare condition.

Trigonitis

Trigonitis is characterized by changes to the tissue of the bladder neck (trigon) in which normal bladder lining cells are replaced with skin-derived cells.

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Sources

• Macpherson, Gordon Black’s Medical Dictionary (London: A & C Black Publishers Ltd, 2002)
• Kilmartin, Angela The Patient’s Encyclopaedia of Cystitis, Sexual Cystitis, Interstitial Cystitis (London: Angela Kilmartin, 2002)
• Gillespie, Larrian You Don’t Have to Live with Cystitis (New York: Avon Books, 1996)
• COB Foundation Bladder Conditions http://www.cobfoundation.org/bladder-conditions (June 2016)
• Herrman, V. et al Urinary Tract Infections: Pathogenesis and Related Conditions Int Urogynecol J (2002) [13:210–213] available at: http://link.springer.com/article/10.1007%2Fs192-002-8355-4#page-1

1. Macpherson, Gordon Black’s Medical Dictionary (London: A & C Black Publishers Ltd, 2002), p. 153
2. Herrman, V. et al Urinary Tract Infections: Pathogenesis and Related Conditions Int Urogynecol J (2002) [13:210–213] available at: http://link.springer.com/article/10.1007%2Fs192-002-8355-4#page-1
3. Kilmartin, Angela The Patient’s Encyclopaedia of Cystitis, Sexual Cystitis, Interstitial Cystitis (London: Angela Kilmartin, 2002), p. 25
4. Ibid, p. 5-6
5. Gillespie, Larrian You Don’t Have to Live with Cystitis (New York: Avon Books, 1996), p.17
6. Macpherson, Gordon Black’s Medical Dictionary (London: A & C Black Publishers Ltd, 2002), p.525
7. COB Foundation Cystitis http://www.cobfoundation.org/bladder-conditions/cystitis (June 2016)